Central Sensitization and CaVα2δ Ligands in Chronic Pain Syndromes: Pathologic Processes and Pharmacologic Effect
| Autor: | Jeannette A. Barrett, Michael M. Tuchman, Charles Taylor, Sean D. Donevan, Thomas G. Hedberg |
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| Rok vydání: | 2010 |
| Předmět: |
Gabapentin
Voltage-dependent calcium channel business.industry Pregabalin Chronic pain Long-term potentiation Pharmacology medicine.disease Anesthesiology and Pain Medicine Allodynia Neurology Hyperalgesia medicine NMDA receptor Neurology (clinical) medicine.symptom business Neuroscience medicine.drug |
| Zdroj: | The Journal of Pain. 11:1241-1249 |
| ISSN: | 1526-5900 |
| DOI: | 10.1016/j.jpain.2010.02.024 |
| Popis: | Central sensitization is one form of long-term plasticity in the central nervous system. Sustained activation of primary sensory fibers supplying dorsal horn can induce long-lasting increases in the discharge amplitude of primary afferent synapses. This is similar to the long-term potentiation that occurs in many other CNS regions. Drugs that limit the short-duration wind-up component of central sensitization include sodium channel blockers, NMDA antagonists, fast-acting opioids and the calcium-channel ligands gabapentin and pregabalin (S-3-(aminomethyl)-5-methylhexanoic acid). Pregabalin, like gabapentin, binds selectively to the Ca V α 2 δ auxiliary subunit of presynaptic voltage-gated calcium channels. The conformational changes induced by this binding inhibit abnormally intense neuronal activity by reducing the synaptic release of glutamate and other neurotransmitters. Recent identification in animal models of increased Ca V α 2 δ protein expression in chronic pain, allodynia, and hyperalgesia have drawn additional interest to drugs that bind the Ca V α 2 δ site. Experimental studies with animal models and healthy human volunteers have shown that pregabalin reduces nociceptive responses, particularly in conditions involving central sensitization. Since these actions occur with relatively modest effects on physiological and cognitive functions, pregabalin may be an important consideration in the pharmacotherapy of otherwise difficult-to-treat pain syndromes. Perspective This focus article discusses how the central nervous system plasticity phenomenon, central sensitization, is established in the induction and maintenance of chronic pain, allodynia, and hyperalgesia. In addition, it explores the neurophysiologic actions of the calcium-channel ligands gabapentin and pregabalin in limiting pathological manifestations of central sensitization. |
| Databáze: | OpenAIRE |
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